Type 2 diabetes used to be referred to as adult-onset diabetes. However, more and more pediatric patients are being diagnosed with this condition, necessitating a name change. As of 2026, type 2 diabetes accounts for 20% of all new pediatric diabetes diagnoses.
While this trend in diagnoses is concerning, healthcare providers can make a difference. Understanding risk factors, goals of therapy, treatment options, and barriers to care can prove significant when addressing vulnerable populations.
Risk factors for type 2 diabetes in children
Risk factors for type 2 diabetes in children are similar to risk factors for the adult population. These include:
Family history
Over 75% of children diagnosed with type 2 diabetes have an affected relative. According to the Korean Journal of Internal Medicine, children of parents with type 2 diabetes have a 2-to 4-times increased risk of developing the condition.
Obesity
Children with obesity are four times more likely to be diagnosed with type 2 diabetes than children within a healthy weight range. The Endocrine Society states that up to 75% of children diagnosed with type 2 diabetes fall into the “obese” category.
Experts define obesity in children as a body weight above the 95th percentile for their age, height, and sex.
Related CE course for nurses: Pediatric Diabetes: Diagnosing, Managing, & Treating
Low family income
Like many chronic illnesses, low socioeconomic status increases the risk of type 2 diabetes in children. This is primarily driven by:
- A lack of access to nutritious food
- Reduced number of spaces for safe outdoor play
- Limited healthcare resources
Chronic illnesses in children are also linked to lower education levels in parents, which are more common in lower-income families.
Ethnicity
According to the Journal of Diabetic Medicine, rates of type 2 diabetes are disproportionately high in children belonging to minority groups. Specifically, these include black, Hispanic, American Indian, American Alaskan native, and Pacific Islander populations.
Diagnostic criteria of type 1 vs type 2 diabetes
While both type 1 and type 2 diabetes are related to problems with blood glucose regulation, the metabolic conditions that cause these issues are not the same. Type 1 diabetes is an autoimmune condition that impacts the pancreas’s ability to produce insulin. In contrast, type 2 diabetes is caused by cells’ resistance to insulin, meaning that glucose cannot be carried into the cells for energy.
Type 1 diabetes is diagnosed by the presence of autoantibodies (e.g., GAD, IA-2, ZnT8), a fasting blood glucose of greater than 126, and a random blood glucose of greater than 200. Most diagnoses of type 1 diabetes in children are discovered because the child is hospitalized in a state of diabetic ketoacidosis (DKA).
Type 2 diabetes is diagnosed as an A1C of greater than 6.4, a fasting blood glucose greater than 126, and a random blood glucose of 200. This criteria must be met without the presence of autoantibodies and with normal insulin levels. It is often paired with symptoms such as excessive thirst, excessive urination, hunger, and fatigue.
Related CE course for nurses: Diabetes Care and Patient Education
Goals of therapy for children
The goals of treatment for type 2 diabetes in children are similar to those for adults. The main goal of treatment is to keep A1C below 7%. 7% or lower indicates good overall control of blood glucose levels. Blood glucose is typically checked two to three times per day, depending on the severity of the condition.
Children diagnosed with type 2 diabetes are also at a high risk of comorbidities such as hypertension and obesity. In addition to keeping blood glucose levels within acceptable ranges, providers should aim to prevent or treat hypertension, set reasonable goals for weight and growth, and monitor and treat dyslipidemia.
In children, weight loss is rarely a goal of treatment. More often, children are expected to slow weight gain or maintain their current weight as their height increases. Families should be encouraged to add healthy foods and get outside to play rather than restricting calories or starting intense exercise programs.
Pharmacologic therapy in the pediatric population
Metformin is the first-line pharmacological treatment of type 2 diabetes in children over ten years of age. Metformin is designed to increase insulin sensitivity. It is typically only prescribed in serious cases of type two diabetes with A1C greater than 9 or fasting blood glucose consistently greater than 250.
Insulin can also be used for children with type 2 diabetes, but is typically only used for severe cases of the disorder. While it is an extremely effective medication, it is not without risk. An overdose of insulin can have deadly consequences. In addition, insulin requires children to receive or give themselves a subcutaneous injection, which increases the chance of noncompliance.
Newer medications include GLP-1 inhibitors such as Semaglutide or Liragoutide can be added for children who are unresponsive to metformin. These medications are FDA approved for children over the age of 12 who have an initial BMI >95th percentile for their age and height. This medication works by mimicking the GLP-1 hormone, which decreases appetite and increases insulin production.
Psychosocial barriers
Type 2 diabetes can be difficult to manage, even for adults. Children with type 2 diabetes need support and encouragement from the adults in their lives.
Stopping activities to check blood sugar levels, counting carbohydrates, and taking medications can be difficult or even feel embarrassing for many children and adolescents. This can exacerbate noncompliance and lead to poor blood glucose management.
If possible, families should add healthy habits together, avoiding talk about weight loss, and encouraging mobility and consuming nutrient-dense foods. Children often do better when they are included in meal planning, learn to prepare food with their parents or siblings, and find physical activities that they enjoy.
